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Building an Effective Strategy for Crisis Prevention
by Norman A. Wieseler and Ronald H. Hanson
Although crisis response remains an important function of behavior support programs for individuals with challenging behaviors, the ultimate goal for such programs must be to design a behavior support strategy to minimize the possibility of a crisis situation occurring. Crisis prevention requires a coordinated effort to develop an individualized plan for the person at risk. A number of steps are necessary for the development of such a plan, including those below.
Identifying People at Risk
The display of problem behavior patterns is evident to most care providers (e.g., family members, support staff) in their day-to-day interactions with individuals. However, many people’s problem behaviors occur intermittently and in situations where a number of different factors may influence the behavior. The frequency, severity, and circumstances of challenging behaviors become the primary considerations in determining whether an intervention plan should be developed.
Identifying Behavior That May Result in Crisis
Aggressive and destructive behaviors, especially when they put others in physical jeopardy, require a crisis prevention plan. Other behavior, although not inherently dangerous, may also require a plan for crisis prevention (e.g., removing one’s clothing is not inherently aberrant, but if it occurs in public, it becomes problematic). Other behavior may be potentially risky for some individuals or in some circumstances but not others (e.g., walking away from work or home may be an appropriate behavior, but doing so without telling the appropriate person or without possessing the necessary safety skills could subject the individual to dangerous situations).
Identifying Variables Associated with Past Challenging Behavior
Once the behaviors of concern have been recognized, it is essential to determine the factors giving rise to the behavior. Methods for doing so are called functional assessment or functional analysis. Functional assessment is a team activity that includes using interviews, surveys, or rating scales with those who know the individual best, observing the person in the settings and circumstances in which the challenging behavior occurs, and creating analog situations and noting the frequency of the target behavior under different environmental conditions. Information obtained by interviews, surveys, or rating scales must be supported by direct observation. Because approaches to functional assessment may vary in their usefulness and time expenditure for different persons and situations, it is important for the assessment leader to have experience and practical skill in completing the evaluation. This assessment will define the patterns and nature of challenging behavior, predict its occurrence and nonoccurrence, identify the “functions” it serves for the individual (e.g., gaining release from disliked activities), and describe the responses to the behavior (environmental consequences) that make it “work” for the individual.
Identifying Ecological Variables Associated with Behavior
The physical and social environment in which the individual lives exert a major influence on behavior. It is important that the aspects of the physical environment that promote appropriate and challenging behavior be identified. The role of the people working together to improve the individual’s life is to explore, test, and ultimately identify and manage environmental features that influence the occurrence of behaviors that may escalate to crisis proportions (e.g., noise, crowding, fear of another person, lack of privacy, or lack of stimulation).
Identifying Skills That Reduce Likelihood of Challenging Behavior
The absence of appropriate skills by the individual in obtaining recognition from others often results in challenging behavior. It may be effective in obtaining attention, acquiring a preferred item or activity, or escaping from disliked settings or events. If staff react to these behaviors, the problem behaviors become more likely in the future because they produce what the individual wanted (e.g., staff attention, a desired item, or release from a disliked situation). If staff are taught to provide the individual with attention prior to the problem behavior, they are likely to be effective in curtailing the behaviors. If effective in reducing problem behaviors, staff attention is then more likely in the future and both the problem behavior and staff response are reciprocally strengthened. However, short-term solutions can have deleterious long-term effects that make problem behavior more likely. It is, therefore, important to identify and teach alternative ways that people can get what they want and avoid what they do not want. An inventory of skills that would, if strengthened, allow the individual more environmental control must be identified for crisis prevention. It is important for the person to acquire replacement skills that are as efficient and effective as the challenging behavior.
Identifying Environmental Changes That Are Preventative
Planful changes in the physical, social, and procedural features of people’s lives can contribute to crisis prevention. The people engaged in such planning must attend to individual preferences ranging from broad aspirations such as movement from sheltered work to supported employment, or from group homes to their own homes. Additional considerations are adjustments in the physical environment to better accommodate the individual’s physical needs or the enhancement of community activities to provide more opportunities to develop or foster closer friendships.
Identifying Alternative Skills Needed to Control Challenging Behavior
Teaching appropriate skills that are functionally equivalent to the challenging behavior in acquiring environmental control is an important intervention strategy. The acquired alternative behavior must be at least as efficient and effective as the problem behavior in obtaining environmental control. If the desired behaviors are not, it is unlikely the alternative skill will be demonstrated by the individual. Strategies such as functional communication, self-management, skill building, differential reinforcement of alternative positive behaviors, anger management, progressive relaxation, and development and practice of social skills may become very important in planning crisis prevention for a particular individual.
Developing a Behavior Support Plan for Crisis Prevention
The development of a behavior support plan for crisis prevention requires the coordinated effort of all people engaged in the individual’s life. Many techniques used in the development of an effective plan require the expertise of disciplines not usually available within the interdisciplinary team of service coordinators, family members, direct support staff, and others. Consequently, it is imperative to include in the process consultants with the expertise needed to assist in the development of adequate crisis prevention and response.
Consultants can often be necessary and effective participants in the development of a comprehensive behavior support plan. Their suggestions must be congruent with the direct service providers’ values and skills in the sites where implementation will occur. The consultant’s challenge is to assist in designing a behavior support plan grounded in the principles of behavior analysis that closely matches person-centered values and the resources of the other family, friends, and professionals in the person’s life. This assures the contextual fit between the plan and the values and skills of people who must carry it out.
Although the behavior support plan for crisis prevention is tailored for the individual at risk, it is important that those who develop it recognize that the plan is developed for the care provider’s behavior. It is unlikely a support plan will be implemented as written if it is not congruent with implementors’ levels of skill, styles of interaction shaped by values, and shared goals.
Support Plan Implementation
It is essential that support plan strategies are embedded in the individual’s normal rhythm of life. The personal characteristics of the individual, the values and skills of the care providers, and the nature and demands of the environment in which the plan will be implemented are factors which need to be fully considered. Maintaining typical routines, the person’s associations with others, and the activities in home, school, work, or other community settings should happen whenever possible unless it is evident that any of these put the person at risk of displaying challenging behaviors.
Once the behavior support plan is developed and implemented, maintenance of the plan across settings becomes critical. This requires the team leader or consultant to have frequent interactions with persons playing key support roles in the life of the individual to obtain information about the workability of the plan and comfort level of care providers in implementing it. This interaction allows for a fine-tuning of the components to maintain crisis prevention. When the individual’s support providers are involved in the functional assessment and behavior support plan development, contextual fit is facilitated and occurs most naturally.
Conclusion
Each of these steps is important in building an effective strategy for preventing crisis situations. To be optimally effective, each person involved in supporting the individual must share the common goal of preventing crisis situations rather than only responding after the crisis has occurred. The opinions of each, regardless of their relationship with the individual or their professional status, must be valued and considered when planning for crisis prevention. Having an effective behavior support plan designed from the experience and suggestions of all those engaged with the individual helps to ensure the person’s continued success in remaining in the community while also assuring attention to his or her right to pursue a high quality of life.
Norman A. Wieseler is a Licensed Psych-ologist with Eastern Minnesota Community Support Services, Faribault, Minnesota. He may be reached at 507/333-2093 or by e-mail at norman.wieseler@state.mn.us.
Ronald H. Hanson is consulting psychologist with Mount Olivet Rolling Acres, Victoria, Minnesota. He may be reached at 763/475-9614 or by e-mail at rhanson@mninter.net.
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Citation: Hanson, R., Wieseler, N., & Lakin, K. (2000). Impact: Feature Issue on Behavior Support for Crisis Prevention and Response, 14(1) [online]. Minneapolis: University of Minnesota, Institute on Community Integration. Available from http://ici.umn.edu/products/impact/141/. __________ Hard copies of Impact are available from the Publications Office of the Institute on Community Integration. The first copy of this issue is free; additional copies are $4 each. You can request copies by phone at 612-624-4512 or E-mail at icipub@umn.edu, or you can fax or mail us an order form. See our listing of other issues of Impact for more information. The print design version (PDF, 448K, 28 pp.) of this issue of Impact is also available for free, complete with the color layout and photographs. This version looks the most like the newsletter as it was printed. The University of Minnesota is an equal opportunity employer and educator.
